NPIMap

Organization Active NPI

Sky Lakes Medical Center Inc

  • Health Service Clinic/Center
  • Klamath Falls, OR
National Provider Identifier
1962000661
Registry record updated Oct 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
SKY LAKES MEDICAL CENTER INC
Practice address
128 S 11TH St
Klamath Falls, OR 97601-5806
Phone
(541) 274-2770
Fax
(541) 274-2779
NPI assigned
Oct 14, 2020
Last updated
Oct 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer NewtonNPI 1568417194
Title
Dietitian
Phone
(541) 274-2770

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X NU Primary

Addresses

Primary practice location

128 S 11TH St
Klamath Falls, OR 97601-5806

Mailing address

128 S 11TH St
Klamath Falls, OR 97601-5806
Phone (541) 274-2770

Other names 1

  • Sky Lakes Wellness Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210706001216 OR MDPP Supplier - in-Person MDPP Supplier 1052204096 Practice locations: Klamath Falls, OR

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2093405Sky Lakes Wellness Center128 S 11TH St, Klamath Falls, OR 97601Certificate of waiverOct 13, 2027

National Provider Directory

National Provider Directory
Tax ID family
Merle West Medical CNTR23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

128 S 11th St
Klamath Falls, OR 97601
Phone (541) 274-2770

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602633600000",
    "number": "1962000661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 S 11TH ST",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976015806",
            "telephone_number": "541-274-2770",
            "fax_number": "541-274-2779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 S 11TH ST",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976015806",
            "telephone_number": "541-274-2770",
            "fax_number": "541-274-2779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKY LAKES MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-14",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A",
        "authorized_official_last_name": "NEWTON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "DIETITIAN",
        "authorized_official_telephone_number": "541-274-2770"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sky Lakes Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Klamath Falls, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.